‘Colonising the body': tropical medicine as a tool of medicalisation?24
The understanding of infectious diseases, the accumulation of knowledge surrounding them, and the effectiveness of control measures reinforced the goals of modern colonisation in the first decades of the twentieth century.
In 1897, the British Medical Journal wrote: ‘Get rid of or avoid these disease germs and we get rid of a principal obstacle to the colonisation of the tropics by Europeans.’25 To use the phrase of former gouverneur-general in French Indochina and French Minister of the Colonies Albert Sarraut (1872—1962), modern medicine aided the ambition of mise en valeur (improvement) of the colonies. According to British Secretary of State for the Colonies Joseph Chamberlain (1836—1914), medicine was an essential element of ‘constructive imperialism’, by which he meant the exploitation of under-developed estates in the colonies for economic benefit.26 At the same time, the Ethische Politiek (ethical policy) of the Netherlands both aimed to provide medical care to the colonised populations and further the economic exploitation of the colonies. Medicine became one of the means to bring Western civilisation to the indigenous population of the colonies.27 In 1926, French military officer and former resident-general of the Moroccan protectorate, Hubert Lyautey (1854—1934), claimed that ‘the only excuse for colonisation is medicine.’28Up until the end of the nineteenth century, most research into the diseases of the tropics had been conducted in the colonies. In the first decade of the twentieth century, tropical medicine became institutionalised in the major cities of the Western world. In 1899, the London School for Hygiene and Tropical Medicine, headed by Manson, now known as the father of tropical medicine, opened its doors. In the same year, the Liverpool School of Tropical Medicine was established.
In France, a number of Instituts de Medecine Coloniale were organised before the opening in 1906, in Marseilles, of the influential Pharo Institute, a school for tropical medicine organised by and for the French military working overseas. In the same decade, the Netherlands Colonial Institute in Amsterdam organised a division of tropical medicine, and the Hamburg Institute of Research in Tropical Medicine and Ship Hygiene, the Brussels School of Tropical Medicine, and the Australian Institute of Tropical Medicine (in Townsville and later Sydney) were created. In the United States, departments of tropical medicine were founded in a number of medical schools with funding from the Rockefeller Foundation: Harvard (1900), New Orleans (1902), Tulane (1913) and Johns Hopkins (1916). Teaching programmes focussed on parasitology and public health.After the turn of the twentieth century, medical care in the colonies became much more significant. Before 1900, the health of the indigenous population was mostly taken care of by missionaries, although a small number of indigenous individuals could be found in mental hospitals. Colonial governments embarked on health policies (programmes of Assistance Medicale Indigene in the French colonies, for instance, were created between 1899 and 1905) that benefited the indigenous population when this safeguarded the health of Europeans in the colonies. They mostly emphasised public health campaigns that prevented epidemics such as smallpox, plague, malaria and yellow fever. These ‘vertical’ campaigns—that is, targeted to a single disease—were often organised in a military style and consisted of a range of measures that were forced on the indigenous population. In many places, vaccination against smallpox was mandatory, as were measures aimed at limiting the plague, such as isolation of patients and destruction of houses that might provide shelter to rats. Individuals with leprosy were isolated in special institutions (even after it became known that the disease is not very contagious), as were individuals with mental illness.
Enforced syphilis and sleeping sickness screening, interrupting burial rites for punctures and autopsies, and impeding free movement of people were often implemented in the name of public health and modernisation. In most colonies, by contrast, individual health care in hospitals or provided by private physicians, and access to efficient pharmaceuticals were limited to Europeans and wealthy indigenous individuals. Many health policies and programmes could not be enforced due to the lack of money and personnel. Not surprisingly such measures did not always help the reputation of Western medicine—when and where people had actual access to it. Most indigenous individuals in the colonies continued to rely on indigenous remedies throughout the colonial era.Because it was very expensive to recruit and pay Western physicians to take up positions in the colonies, colonial administrators opened medical schools there for indigenous students. They were convinced that Western medicine would be accepted more easily by the indigenous population if it was provided to them by local intermediaries. Several medical schools were opened in the British Empire. The Medical School of the College of Philadelphia opened in 1765, the King’s College Medical School in New York the following year. In 1835 the Madras Medical College was established, followed by the Medical College of Bengal (Calcutta) the same year. In 1851, the forerunner of the STOVIA (School for the Education of Native Physicians) opened in Batavia, the capital of the Dutch East Indies.29 In the French Empire, medical schools were opened in Algiers (French Algeria, 1857), Pondichery (the chief French settlement in India, 1863), Antananarivo (Madagascar, 1897), Hanoi (French Indochina, 1902) and Dakar (French West Africa, now Senegal, 1918). The graduates of these schools generally received junior positions in the colonial health service and modest pay. They often were sent out to deal with unpleasant and at times dangerous health conditions, such as plague and cholera epidemics.
The graduates from these colonial medical colleges became members of the growing educated elite, and in many places were involved in political movements criticising the colonial government and its health policies. At times they even advocated independence.30 These graduates also organised medical education and medical care after colonies became independent. In some places they also played a major role in the revitalisation of local traditional medicines by subjecting them to scientific research.31In the 1920s a number of initiatives on public health education were undertaken in the conviction that health gains could only be made when the indigenous population gained insight into the nature of health and disease. These initiatives took place both at the local and international levels, often spearheaded by the Rockefeller Foundation.32 The approaches developed by the Foundation and the League of Nations promised to make some forms of health care available outside the major urban centres in the colonies, to develop maternal and child care and to focus more on devastating ‘social diseases’—that were not specifically ‘tropical’—such as tuberculosis, syphilis, trachoma, cancer, leprosy, diabetes and alcoholism. At the 1937 conference on Rural Hygiene in Far-Eastern Countries, held in Bandung, in the Dutch East Indies, such approaches were further explored. Its report recommended collaboration between health agencies, public health education, broader education reform, the development of ‘primary care’ and the use of auxiliary indigenous health personnel (in the late 1930s, the number of physicians was between 0.8 and 5 per 100,000 people in the colonial world). Participants emphasised the responsibility of governments for making provisions for the sick and how public health could further economic development. This report foreshadowed approaches on health proposed after the Second World War by the World Health Organization established in 1948.33